• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Not coding vs. undercoding

rbynmnk

Contributor
Messages
17
Best answers
0
There is a debate in our office and we need some clarification.

We are all in agreement that under-coding is just as much considered to be fraudulent as over-coding. However, what if the provider wants to not bill for a procedure that he clearly dictates and is billable, is that fraudulent?

Any input would be greatly appreciated.
 

plopez

Guest
Messages
6
Best answers
0
Fraudulent

Sorry but, Yes it can be considered fraud. I just learned this myself. In the event of a lawsuit you would be liable for witholding information. Your medical records will not match the bill you sent. In the event of a lawsuit it would indicate you were hiding something. If for any reason the carrier ask for a copy of the opertative and you did not fully disclose the medical condition and treatment of the patient you may be looking at refunding. One of our nurses did some consulting for a law firm for a while, this is exactly what she was hired to look for.

You might decide to have the doctor dictate seperate opertative reports for the same date of service. Some procedures might be paid in cash and there is no reason to bill the carrier for it. So your medical records would reflect both procedures but would also reflect the REASON you did not bill the carrier.
hope this helps.
 
Top